Medication Review Presentation

2. General Considerations
This lecture will cover medications
commonly taken by sleep lab patients
that are known to have effects on
sleep
The purpose of this lecture is not to
memorize the generic and trade
name of every medication our
patients may ever take!

3. General Considerations
Medication classes that will be covered:
Sedatives and hypnotics
Stimulants
Psychiatric medications
Pain medications
Antiepileptics
RLS/PLMD medications
Cardiovascular medications
Respiratory medications
Cold medications and antihistamines
Recreational drugs

4. General Considerations
3.1 billion prescriptions were written in
2002 in the US alone
Nearly half of all Americans are currently
prescribed at least one medication
Most patients seen at the sleep lab are
under the influence of prescribed
medications
It’s important to know and understand
patients’ medication lists (even OTC drugs)
to correctly read and score studies, and also
for the sake of safety

5. General Considerations
584 prescription and OTC drugs list
sleepiness as a side effect
Of the 20 most commonly
prescribed medications in the US,
at least half are known to affect
sleep

6. 20 most commonly prescribed
brand-name medications
20 most commonly prescribed
generic medications

7. General Considerations
The effects many medications have on
sleep are largely unknown
Even highly controlled studies have
produced differing results
Several factors limit the understanding
of how different medications affect sleep
and wakefulness:
Limited research
Inconsistent findings
Population differences
Acute vs. chronic effects

8. General Considerations
The more medications a patient is on,
the higher the chance of clinically
significant interactions
Physicians should always be aware of a
patient’s medications and instruct the
patient and tech as to their use before
and during the PSG
Any changes to a patient’s regular
medication routine should be clearly
indicated on the study order or history

9. General Considerations
Abbreviations:
SOL – sleep onset latency
○Some charts will use “SL” instead
ROL – REM onset latency
○Some charts will use “RL” instead
TST – total sleep time
SWS – slow-wave sleep
WASO – wake after sleep onset
EDS – excessive daytime sleepiness
I will try to give both generic and trade
names
Trade names will always be capitalized

10. Sedatives and Hypnotics
Sedatives are prescribed to treat
anxiety, and hypnotics are prescribed to
treat insomnia
Nearly identical in how they function and are
often used interchangeably
Have a history of limited efficacy,
serious side effects, addiction, and lethal
toxicity in overdose
Long-term use can lead to tolerance and
actually cause insomnia

11. Sedatives and Hypnotics
All classes bind to GABA receptors in
the brain, inhibiting internal and external
influences from disrupting sleep
Basically “protect” sleep from things such as
worries, noise, and pain
Treating OSA-induced EDS with sedatives
can decrease respiratory drive and increase
prevalence of OSA, actually worsening
sleep
Beware that the effects of multiple
sedatives may be more than additive

12. Sedatives and Hypnotics
3 main categories of hypnotics:
Barbiturates
Benzodiazepines
Non-benzodiazepines

13. Barbiturates
Widely used until the 1960s, but were
often abused and had a high danger of
overdose
Examples:
Trade name Generic name
Luminal phenobarbital
Nembutal pentobarbital
Quaalude, Sopor methaqualone
Doriden glutethimide
Placidyl ethchlorvynol
Nodudor methyprylon

14. Barbiturates
Biggest effect seen on sleep is that they’re
very sedating
Increase TST, decrease REM, increase
spindle frequency and density, increase
SWS
Phenobarbital (Luminal) may actually suppress
SWS
Can decrease respiratory drive and
increase prevalence of OSA
May exacerbate respiratory failure in
patients with COPD, CSA, or restrictive
lung disease

15. Benzodiazepines
Became available in the 1970s, and have less
overdose and abuse potential than
barbiturates
Bind to a broad range of GABA receptors and
have a widespread sedating effect
Examples:
Trade name Generic name
Ativan lorazepam
Klonopin clonazepam
Dalmare flurazepam
Valium diazepam
Xanax alprazolam
Halcion triazolam
Tranzene clorazepate

16. Benzodiazepines
Tend to lose efficacy with prolonged use
Decrease WASO, increase TST,
increase stages N1 and N2, increase
spindle frequency/density, decrease
SWS, decrease REM
Clonazepam (Klonopin) may actually
increase SWS
Are also sometimes used to treat PLMD
Clonazepam (Klonopin) is also used to
treat REM behavior disorder

17. Benzodiazepines
Have similar respiratory effects as
barbiturates:
Can cause respiratory depression, causing or
worsening OSA
Can exacerbate respiratory failure in patients with
COPD, CSA, or restrictive lung disease
Withdrawal can cause REM rebound
Flurazepam (Dalmare), diazepam (Valium),
and clorazepate (Tranzene) have almost 11
day half-lives
Effects may be seen long after being discontinued

18. Non-benzodiazepines
Bind preferentially to GABA
A
receptors
and have a less widespread effect than
benzodiazepines
Examples:
Trade name Generic name
Ambien zolpidem
Benadryl diphenhydramine (also an
antihistamine)
Sonata zaleplon
Lunesta eszopiclone
Rozerem ramelteon
BuSpar buspirone

19. Non-benzodiazepines
Have a relatively short half-life, and have the
fewest side effects of all hypnotics
Buspirone (BuSpar) in particular has been studied
and found to have no effects on sleep architecture or
daytime alertness
Zolpidem (Ambien) and eszopiclone (Lunesta)
have greatest sleep-inducing efficacy, but
zaleplon (Sonata) has fewest side effects
Zaleplon (Sonata) may increase ROL and SWS
Conflicting studies have shown that zolpidem
(Ambien) can either suppress or increase SWS
No REM rebound occurs after discontinuing

21. Stimulants
Increase CNS activation to promote
alertness
Used to treat narcolepsy,
hypersomnia, ADHD, obesity, and
even the common cold
Many of the same medications are
used to treat both narcolepsy and
ADHD

22. Stimulants
Trade name Generic name
Provigil Modafinil
Nuvigil Armodafinil
Strattera atomexetine
Adderall amphetamine
Dexedrine dextroamphetamine
Desoxyn methamphetamine
Concerta, Ritalinmethylphenidate
Trade name Generic name
Didrex benzphetamine
Desoxyn methamphetamine
Adipex phentermine
Meridia sibutramine
Example narcolepsy/hypersomnia/
ADHD medications:
Example appetite suppressants:

23. Stimulants
Most have high potential for abuse and
can cause personality changes, tremor,
hypertension, headaches, and GERD
Newer stimulants modafinil (Provigil)
and armodafinil (Nuvigil) are distinct
from the amphetamines and have a
much lower abuse potential
Now usually the first route of treatment for
narcolepsy

24. Stimulants
Any medications that increase
alertness have the risk of causing
insomnia
Increase SOL, ROL, WASO,
arousals, and stages N1 and N2
Decrease SWS, REM, and TST

25. Stimulants
Common dose-dependent side effects
may also interfere with sleep:
Anxiety
Headache
Irritability
Heart palpitations
Tremors
Sudden withdrawal from any stimulant
substance may cause profound
sleepiness
Beware of how stimulant withdrawal may
affect MSLTs

26. Antidepressants
Four main classes:
SSRIs and SNRIs
Tricyclics
MAOIs
Atypical antidepressants
Each class affects neurotransmitters in
different ways
Each has its own set of side effects,
which range from stimulating to sedating

27. Antidepressants
Most antidepressants affect the
neurotransmitters norepinephrine,
serotonin, acetylcholine, and dopamine
All are known to play an important role in the
sleep-wake cycle
15% of those who take antidepressants
report disrupted sleep or daytime fatigue
Many are sedating, but stopping them prior
to a PSG is not always practical or safe
Almost all classes have been known to
exacerbate PLMD

28. SSRIs and SNRIs
Selective serotonin reuptake inhibitors
affect the neurotransmitter serotonin
SNRIs affect both serotonin and
norepinephrine, and have similar sleep
effects to SSRIs
Trade name Generic name
Prozac fluoxetine
Zoloft sertraline
Celexa citalopram
Lexapro escitalopram
Paxil paroxetine
Luvox fluvoxamine
Trade name Generic name
Cymbalta duloxetine
Effexor venlafaxine
Example SSRIs: Example SNRIs:

29. SSRIs and SNRIs
Generally have the mildest side effects of
all antidepressants
SSRIs tend to be stimulating, and can
cause mild-moderate insomnia
Fluoxetine (Prozac) is the most sleep-disruptive
Can also cause drowsiness in some
individuals
Mostly seen with paroxetine (Paxil) and
fluvoxamine (Luvox)
Decrease TST, increase WASO, decrease
REM, and increase PLMD
Fluoxetine (Prozac) can also decrease SWS

30. SSRIs and SNRIs
Tend to be respiratory stimulants and
can improve OSA
Can cause SEMs to occur during most
of the night, even long after cessation of
drug use
Most prevalent with fluoxetine (Prozac),
paroxetine (Paxil), and sertraline (Zoloft)
Less prevalent with citalopram (Celexa) and
escitalopram (Lexapro)
“Prozac eyes” are often so rapid that they
can easily be mistaken for REMs.

31. SSRIs and SNRIs
MSLT of a patient taking 20mg
fluoxetine daily (30 seconds)

32. SSRIs and SNRIs
Same patient and epoch (120 seconds)

33. SSRIs and SNRIs
Most increase ROL and decrease REM by
about 30%
Knowing this is important for correct interpretation
REM suppression was once believed to be
an important part of treatment
Because of their stimulating effects, SSRIs
and SNRIs can worsen REM behavior
disorder
Despite the sleep disruption caused by these
drugs, patients report sleeping better
subjectively

34. Tricyclics
Have a broader effect on neurotransmitters
Alter norepinephrine, histamine, and
acetylcholine activity
Examples:
Trade name Generic name
Elavil amitriptyline
Norpramin desipramine
Pamelor nortriptyline
Sinequan doxepin
Tofranil imipramine
Vivactil protriptyline

35. Tricyclics
Mildly-moderately sedating
Improve sleep but cause EDS
Protriptyline (Vivactil) less sedating
than others
Increase TST, decrease WASO,
increase SWS, decrease REM, and
increase PLMD

36. MAOIs
Monoamine oxidase inhibitors are the
oldest antidepressants, and have
greatest effects on sleep
Examples:
Trade name Generic name
Marplan isocarboxazid
Nardil phenelzine
Parnate tranylcypromine

37. MAOIs
Tend to be sedating, but can also
cause insomnia
Suppress REM, but effect is more
sustained than with SSRIs
Cause increased WASO,
decreased TST, and markedly
reduced REM

38. Atypical Antidepressants
Work through a variety of mechanisms
and affect multiple neurotransmitters, so
effects on sleep are less known
Examples:
Trade name Generic name
Desyrel trazodone
Serzone nefazodone
Remeron mirtazapine
Wellbutrin bupropion

39. Atypical Antidepressants
Trazodone (Desyrel) and nefazodone
(Serzone) are considered serotonin
antagonist and reuptake inhibitors
Can cause EDS, but may improve sleep
Increase TST and SWS
Conflicting results on REM effects
Mirtazapine (Remeron) is a
norepinephrine and specific serotonin
antagonist
Also causes sedation and EDS but
enhances sleep
Increases TST, decreases SOL

40. Atypical Antidepressants
Bupropion (Wellbutrin), as well as the
tricyclic protryiptiline (Vivactil), are
norepinephrine and dopamine reuptake
inhibitors
Most alerting of antidepressants, and can
cause insomnia
Actually increase REM and don’t exacerbate
PLMD
St. John’s Wort is an herb taken by
some for depression
Has been shown to increase SWS

41. Antidepressants

42. Antipsychotics
Lithium has traditionally been the drug of
choice for treating bipolar disorder
Trade names include Cibalith, Eskalith,
Lithane, and Lithobid
The seizure medication divalproex
(Depakote) is also prescribed to treat the
manic phase of bipolar disorder
Tends to be sedating, causing EDS but
improving sleep
Reduces REM, increases SWS and the
prevalence of arousal disorders such as
night terrors and somnambulism

43. Antipsychotics
Common antipsychotics which are prescribed
for schizophrenia, other psychoses, and
occasionally bipolar disorder:
Characterized mainly by their sedative effect
Chlorpromazine (Thorazine) can cause an increase
in SWS; diffuse, slower activity in the EEG; and a
decrease in spindle activity
Trade name Generic name
Thorazine chlorpromazine
Haldol haloperidol
Mellaril thioridazine
Risperdal risperidone
Seroquel quetiapine
Zyprexa olanzapine

44. Chantix
Smoking cessation aid that works by
blocking nicotine receptors in the brain
Makes smoking have less of a pleasurable
effect
Known to cause insomnia and vivid,
unusual dreams
Watch for symptoms of stimulant
withdrawal

45. Pain Medications
Many prescription pain medications are
either narcotics or barbiturates
Are often VERY sedating
Examples:
Trade name Generic name
Vicodin, Lortab hydrocodone
Darvocet propoxyphrene
Demerol meperidine
Methadone methadone
Percocet oxycodone
Norgesic orphenadrine
--- morphine
--- codeine

46. Pain Medications
Decrease SOL and WASO, increase TST, may
decrease SWS and REM
May decrease alpha, and can cause slower,
diffuse EEG
Can depress respiratory system and increase
severity of OSA
Have been known to cause confusion in elderly
patients
Aspirin (ASA or acetylsalicylic acid) in an
NSAID taken for pain or to prevent heart attack
Main effect on sleep is a decrease in SWS

47. Antiepileptic and Neuromuscular
Medications
Prescribed to treat epileptic seizures as
well as muscle pain caused by injury
Include both muscle relaxants and
anticonvulsants
Example muscle relaxants:
Trade name Generic name
Flexeril cyclobenzaprine
Soma carisoprodol

48. Antiepileptic and Neuromuscular
Medications
Example anticonvulsants:
Topiramate (Topamax) is also prescribed to
treat migraine headaches
Divalproex (Depakote) is also prescribed for
bipolar disorder
Trade name Generic name
Depakote divalproex
Dilantin phenytoin
Neurontin gabapentin
Tegretol carbamazepine
Topamax topiramate
Keppra levetiracetam

49. Antiepileptic and Neuromuscular
Medications
Tend to be very sedating
Phenytoin (Dilantin) may increase
SWS, decrease alpha, and cause
diffuse, slower EEG activity
Anticonvulsants also tend to reduce
REM

50. RLS/PLMD Medications
Restless leg syndrome and periodic limb
movement disorder occur in up to 15%
of the population
Often occur comorbidly
Frequency of RLS/PLMD increases with
age
Historically treated with
benzodiazepines, particularly
clonazepam (Klonopin)
Newer drugs affect mainly dopamine
receptors

51. RLS/PLMD Medications
Examples:
Carbidopa and levodopa (Sinemet) have
been reported to induce vivid dreams or
nightmares, hallucinations, vocalizations, and
somnambulism
○Rarely used due to the potential for
tachyphylaxis and augmentation of symptoms
Trade name Generic name
Sinemet carbidopa/levodopa
Permax pergolide
Mirapex pramipexole
Requip repinirole
Eldepryl selegiline

52. RLS/PLMD Medications
Tend to reduce SWS and REM
Conflicting studies have shown levodopa
either increases or decreases REM
Common side effects are nausea and
headache, which may also interfere with
sleep
Usually improve sleep quality and
decrease arousals
Pramipexole (Mirapex) was originally
developed to treat Parkinson’s Disease
May cause sudden attacks of uncontrollable
sleepiness in some individuals

53. Antihypertensives
Different classes have
different methods of
action, but the desired
effect is to lower blood
pressure
Classes include
diuretics, beta-blockers,
alpha-beta-blockers,
ACE inhibitors, calcium
channel blockers, and
vasodilators
Examples:
Trade name Generic name
Inderal propranolol
Tenormin atenolol
Lopressor metoprolol
--- pindolol
--- reserpine
Catapres clonidine
Coreg carvedilol
Cozaar losartan
Privinil, Zestrillisinopril

54. Antihypertensives
May suppress REM and increase SWS
Have been reported to cause insomnia,
nightmares, vivid dreams, hallucinations,
vocalizations, somnambulism, and EDS
Most sleep effects seen with clonidine
(Catapres)
Fewest sleep effects seen with atenolol
(Tenormin)

55. Diuretics
Work by stimulating the kidneys to
excrete more sodium into the urine
This draws excess fluid out of cells so it can
be eliminated from the body
Although mainly prescribed to treat high
blood pressure, are also commonly used
to treat edema caused by heart failure,
kidney disease, or liver cirrhosis

56. Diuretics
Examples:
The main effect on sleep is excessive
urination, which can cause frequent
nocturnal awakenings
A possible side effect is potassium
deficiency, which can cause nocturnal
cramping of the calf muscles
Trade name Generic name
Bumex bumetanide
Zaroxolyn metolazone
Aquazide, Microzide hydrochlorothiazide (HCTZ)
Lasix furosemide

57. Hypolipidemics
Work to lower cholesterol by blocking
its production by or absorption into the
body
Along with antihypertensives, are
some of the most common drugs
taken by sleep lab patients

58. Hypolipidemics
Examples:
No consistent findings on sleep and
wakefulness
Insomnia reported rarely with atorvastatin (Lipitor)
and lovastatin (Mevacor, Altoprev)
Trade name Generic name
Caduet amlodipine/atorvastatin
Vytorin ezetimibe/simvastatin
Zetia ezetimibe
Tricor fenofibrate
Lipitor atorvastatin
Mevacor, Altoprev lovastatin
Pravachol pravastatin
Crestor rosuvastatin
Zocor simvastatin

59. Antiarrhythmatics
Work by slowing down the heart rate to
treat fast arrhythmias such as atrial
fibrillation, atrial flutter, ventricular
fibrillation, and ventricular tachycardia
Includes a vast array of medications that
work through a variety of mechanisms
How they affect sleep has been largely
inconclusive
Atrial
fibrillation

60. Antiarrhythmatics
Examples:
Trade name Generic name
--- quinidine
Tambocor flecainide
Rythmol propafenone
Ethmozine moricizine
Calan verapamil
Cardizem diltiazem
Procardia nifedipine
Lanoxin digoxin
Coumadin warfarin

61. Antiarrhythmatics
Most common complaint is daytime
fatigue
Most important thing to be aware of
with these drugs is that they
indicate the patient has a
documented history of cardiac
arrhythmias, so be very vigilant!

62. Respiratory Medications
The most common respiratory
conditions that require long-term
medication are asthma and COPD
Examples:
Theophylline (Aerolate) is chemically related
to caffeine, and doses are usually high
enough to disrupt sleep
Trade name Generic name
Proventil, Ventolin albuterol
Maxair pirbuterol
Aerolate theophylline
--- aminophylline
Atrovent ipratropium

63. Respiratory Medications
Work by stimulating the central nervous
system, which can cause insomnia,
especially if taken shortly before
bedtime
Corticosteroids like prednisone are
prescribed for asthma as well as for joint
pain and inflammation
Can cause jitters and insomnia
Increase appetite and can cause fluid
retention
○Any weight gain can increase the risk of OSA

64. Decongestants
Work by reducing blood flow to the mucus
membranes so that less mucus is
produced
Examples include oxymetazoline (Afrin),
phenylphrine (Contac-D, Sudafed PE), and
phenylpropanolamine (Phenyldrine), but
most common decongestant is
pseudoephedrine
Pseudoephedrine can be found in:
Actifed, Advil Cold & Sinus, Aleve Cold & Sinus,
DayQuil, NyQuil, Dimetapp, Robitussin, Sudafed,
Triaminic, Tylenol Cold, and most drugs that end in “-D”

65. Decongestants
Most cause some degree of CNS
stimulation, which may result in
insomnia
Particularly true w/ drugs containing
pseudoephedrine
Pseudoephedrine has been reported to
induce hallucinations, vocalizations, and
somnambulism
Ephedrine in brain = adrenaline in body

66. Antihistamines
Work by blocking histamine, a
neurotransmitter that’s responsible for
allergy symptoms but that also promotes
wakefulness
Examples:
Trade name Generic name
Zyrtec cetirizine
Astelin azelastine
Benadryl diphenhydramine
Allegra fexofenadine
Claritin, Alavert loratadine
Clarinex desloratadine
Dramamine dimenhydrinate

67. Antihistamines
Tend to be sedating, and can cause
drowsiness
Diphenhydramine (Benadryl) also used as a
sleep aid
Shorten SOL, decrease REM, decrease
arousals, and increase TST
Newer antihistamines such as cetirizine
(Zyrtec) have fewer side effects
Taking antihistamines before bed can
result in a dry mouth and drowsiness
upon awakening

68. Cold Medications and
Antihistamines
Many cold medications contain an antihistamine
as well as a decongestant, so side effects may
be unpredictable and can vary greatly from one
patient to the next
Most cold medications
are available OTC, so
they’re readily
accessible to patients

69. Alcohol
Affects GABA receptors in the brain
Consumed close to bedtime, can
initially be very sedating
At least 25% of insomniacs report
using alcohol as a sleep aid
Those with greater trouble sleeping
are more likely to have diagnosable
alcoholism

70. Alcohol
In the first half of the night, NREM is
increased and REM is reduced
In the second half of the night,
withdrawal symptoms occur, particularly
in heavy drinkers
Shallow, disrupted sleep; late-night REM
rebound; nightmares; sympathetic nervous
system arousal; tachycardia; sweating
Decreases SOL and REM, increased
WASO (especially in second half of the
night)

71. Alcohol
Relaxes muscles of the upper
airway
This can cause or worsen snoring and
OSA
Alcoholics often report insomnia,
hypersomnia, circadian rhythm
disturbances, and parasomnias
Recovering alcoholics may have
abnormal sleep patterns for years after
becoming sober

72. Caffeine
Binds to adenosine receptors
in the brain, blocking the
sleep-inducing neurotransmitter
adenosine from having an effect
Consumption of large amounts may lead
to restlessness, nervousness,
excitement, insomnia, flushed face, and
GI problems
1000mg can produce insomnia, dyspnea,
delirium, and arrhythmias
Doses above 5000mg can be fatal

73. Caffeine
Because it’s so prevalent,
it’s easy to ingest large
amounts unintentionally.

74. Caffeine
Chronic daily use leads to tolerance and
dependence
Half-life is 3-7 hours, so even caffeine
consumed in the afternoon can disrupt sleep
at night
Effect more pronounced in children, pregnant
women, the elderly, and people with
hypothyroidism
Increases arousals, decreases TST and SWS
Beware that caffeine is present in many
headache medications (e.g., Excedrin
Migraine)

75. Nicotine
Approximately 23% of adults in the US use
nicotine products
Conflicting reports on how it affects sleep
May be sedating in lower doses but altering in
higher doses
Also conflicting reports on how it affects REM
Some reports have shown an increase while
others have shown a decrease
Nicotine patches deliver small doses of
nicotine into the bloodstream around the clock
Can cause insomnia and disturbing dreams

76. Other Recreational Drugs
Marijuana (tetrahydracannibinol)
Effects on sleep very similar to alcohol
May induce sleepiness
Opiates
May induce sleepiness but cause
REM suppression
Can increase SWS and prevalence of
night terrors and somnambulism

77. Other Recreational Drugs
Amphetamines
Can be useful as prescription
stimulants, but some forms
(particularly methamphetamine) have
a high abuse potential when used as
recreational drugs
Effects tend to be dose-dependent, so
recreational users may have even
more disturbed sleep than those who
take prescription amphetamines as
prescribed

78. Helpful Hints
Drugs that can cause nightmares or
vivid dreams:
Antihistamines, benzodiazepines, beta-
blockers, dopaminergics, isotretinoin,
ofloxacin, naproxen, thiothixene, verapamil,
varenicline
Drugs that can cause excessive daytime
sleepiness:
Antihistamines, antihypertensives, anti-
nausea agents, dopamine agonists,
antiepileptics

79. Helpful Hints
Drugs that can
cause insomnia:
Amphetamines,
antiretrovirals, anti-
influenza drugs,
cholesterol-
lowering drugs,
corticosteroids

80. Helpful Hints
Following are some tips for
recognizing the class of unfamiliar
drugs
Some precautions:
These only work on generic names, as
trademarked drugs are often named
arbitrarily and for marketing purposes
These tips aren’t applicable in all
cases – they’re a general trend, not a
hard and fast rule

81. Helpful Hints
Generic drug names that: Are usually:
Contain “barb” Barbiturates
End in “-pam” or “-lam” Benzodiazepines
Contain “amphetamine” Amphetamines
End in “-oxetine” or “-pram” SSRI antidepressants
End in “-triptyline” Tricyclic antidepressants
Start or end with “lith” Lithium preparations
End in “-dopa” Dopaminergic Parkinson’s drugs
End in “-lol’ Beta-blockers
Contain “statin" Cholesterol-lowering statins
End in “-buterol” or “-phylline”Respiratory medications

82. Conclusion
The vast array of substances available
to our patients will continually challenge
our ability to interpret PSGs
As technologists, we must remain aware
of the latest trends in the use and abuse
of various drugs
We must know if and how each PSG
might be affected by a patient’s
medications, including those NOT taken
the night of the study

83. Questions,Concerns,Feedback
Should you have any questions or
feedback regarding this presentation
please feel free to contact our program
director, Jennifer Brickner-York, at
[email protected].
Thank You.

84. References
Boehringer Ingelheim Pharmaceuticals, Inc. (2005). PDR
pharmacopoeia: Pocket dosing guide 2006. Deerfield, IL:
Astellas Pharma US.
Butkov, N., & Lee-Chiong, T. (Eds.). (2007).
Fundamentals of sleep technology. Philadelphia, PA:
Lippincott Williams & Wilkins.
Lenik, S.H. (2009). Handbook for sleep medicine
technologists. Denver, CO: Outskirts Press.
Neubauer, D.N. (2008). Medication effects on sleep.
(2008). ACCP Sleep Medicine Review Board syllabus
book, ed. C.W. Atwood.
Pandi-Perumal, S.R., Ruoti, R.R., & Kramer, M. (Eds.).
(2007). Sleep and psychosomatic medicine. Boca Raton,
FL: Informa Healthcare.
Silverman, H.M. (1998). The pill book. New York, NY:
Bantam.